Care for critically and terminally ill patients and moral distress of physicians and nurses in tertiary hospitals in South Korea: A qualitative study

Physicians and nurses working in acute care settings, such as tertiary hospitals, are involved in various stages of critical and terminal care, ranging from diagnosis of life-threatening diseases to care for the dying. It is well known that critical and terminal care causes moral distress to healthcare professionals. This study aimed to explore moral distress in critical and terminal care in acute hospital settings by analyzing the experiences of physicians and nurses from various departments. Semi-structured in-depth interviews were conducted in two tertiary hospitals in South Korea. The collected data were analyzed using grounded theory. A total of 22 physicians and nurses who had experienced moral difficulties regarding critical and terminal care were recruited via purposive maximum variation sampling, and 21 reported moral distress. The following points were what participants believed to be right for the patients: minimizing meaningless interventions during the terminal stage, letting patients know of their poor prognosis, saving lives, offering palliative care, and providing care with compassion. However, family dominance, hierarchy, the clinical culture of avoiding the discussion of death, lack of support for the surviving patients, and intensive workload challenged what the participants were pursuing and frustrated them. As a result, the participants experienced stress, lack of enthusiasm, guilt, depression, and skepticism. This study revealed that healthcare professionals working in tertiary hospitals in South Korea experienced moral distress when taking care of critically and terminally ill patients, in similar ways to the medical staff working in other settings. On the other hand, the present study uniquely identified that the aspects of saving lives and the necessity of palliative care were reported as those valued by healthcare professionals. This study contributes to the literature by adding data collected from two tertiary hospitals in South Korea.

Download Full-text

NEEDS OF PATIENTS NEEDING PALIATIVE CARE

Knowledge International Journal ◽

10.35120/kij3404997b ◽

2019 ◽

Vol 34 (4) ◽

pp. 997-1002

Author(s):

Tsvetka Boycheva ◽

Mariya Dimitrova

Keyword(s):

Palliative Care ◽

Healthcare System ◽

Healthcare Professionals ◽

Unmet Need ◽

Terminally Ill ◽

Care Plan ◽

Terminally Ill Patients ◽

Palliative Care Teams ◽

Seriously Ill Patients ◽

Seriously Ill

Palliative care satisfies the physical, mental, social, cultural and spiritual needs of terminally ill patients. They target the family and loved ones of the sick, provide support and training, help people overcome the grief and sorrow of losing a loved one. Palliative care for a lot of people becomes a necessity at some point in their lives, enabling them to adequately complete their earthly journey. The patients undergoing these care have gone through diagnosis and treatment and are in the last stages of their lives, filled with much suffering, pain and hopelessness. The purpose of this study is to determine the extent to which the healthcare system is able to meet the specific needs of patients in need of palliative care. The study focuses on 602 relatives of seriously ill patients and 376 healthcare professionals caring for terminally ill patients. Using a direct individual survey, their opinion was examined. Statistical methods have been used to process and analyze the results. The study was conducted from 01.11.2017 to 30.11.2018 in a total of 30 hospitals, hospices and social homes in the country. Results: Almost half of the healthcare professionals surveyed (46.0%) devised an individual care plan for each patient, and every third of the seriously ill relatives (36.8%) felt that they were tailored to the individual needs of each patient. In the current health care system, the offered palliative care is able to meet patients' physical and social needs, but their mental, spiritual and cultural needs remain somewhat unmet. Conclusions: The lack of sufficient time to communicate with the patient and the lack of staff in the healthcare system are the reasons for the unmet need of the terminally ill. Creating training programs for healthcare professionals to improve their communication knowledge and skills, as well as the inclusion of different specialists in palliative care teams, will increase care coverage and improve the quality of life of seriously ill patients and their families.

Download Full-text

Symptom clusters and their influence on prognosis using EORTC QLQ-C15-PAL scores in terminally ill patients with cancer

Supportive Care in Cancer ◽

10.1007/s00520-021-06380-w ◽

2021 ◽

Author(s):

Nanako Koyama ◽

Chikako Matsumura ◽

Yuuna Tahara ◽

Morito Sako ◽

Hideo Kurosawa ◽

...

Keyword(s):

Palliative Care ◽

Terminally Ill ◽

Symptom Clusters ◽

Rank Test ◽

Appetite Loss ◽

Patients With Cancer ◽

Terminally Ill Patients ◽

Log Rank Test ◽

Eortc Qlq ◽

Cluster 2

Abstract Purpose The aims of the present study were to investigate the symptom clusters in terminally ill patients with cancer using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 15 Palliative Care (EORTC QLQ-C15-PAL), and to examine whether these symptom clusters influenced prognosis. Methods We analyzed data from 130 cancer patients hospitalized in the palliative care unit from June 2018 to December 2019 in an observational study. Principal component analysis was used to detect symptom clusters using the scored date of 14 items in the QLQ-C15-PAL, except for overall QOL, at the time of hospitalization. The influence of the existence of these symptom clusters and Palliative Performance Scale (PPS) on survival was analyzed by Cox proportional hazards regression analysis, and survival curves were compared between the groups with or without existing corresponding symptom clusters using the log-rank test. Results The following symptom clusters were identified: cluster 1 (pain, insomnia, emotional functioning), cluster 2 (dyspnea, appetite loss, fatigue, and nausea), and cluster 3 (physical functioning). Cronbach’s alpha values for the symptom clusters ranged from 0.72 to 0.82. An increased risk of death was significantly associated with the existence of cluster 2 and poor PPS (log-rank test, p = 0.016 and p < 0.001, respectively). Conclusion In terminally ill patients with cancer, three symptom clusters were detected based on QLQ-C15-PAL scores. Poor PPS and the presence of symptom cluster that includes dyspnea, appetite loss, fatigue, and nausea indicated poor prognosis.

Download Full-text

Japanese physicians’ experiences of terminally ill patients voluntarily stopping eating and drinking: a national survey

BMJ Supportive & Palliative Care ◽

10.1136/bmjspcare-2017-001426 ◽

2017 ◽

Vol 9 (2) ◽

pp. 143-145 ◽

Cited By ~ 8

Author(s):

Takuya Shinjo ◽

Tatsuya Morita ◽

Daisuke Kiuchi ◽

Masayuki Ikenaga ◽

Hirofumi Abo ◽

...

Keyword(s):

Palliative Care ◽

National Survey ◽

Clinical Setting ◽

Deep Sedation ◽

Terminally Ill ◽

Treatment Decision ◽

Mail Questionnaire ◽

Terminally Ill Patients ◽

Continuous Deep Sedation

ObjectivesVoluntarily stopping eating and drinking (VSED) could be regarded as a patients’ own non-treatment decision that hastens death, which involves patients voluntarily forgoing food and liquid until death. The aims of this study were to investigate the experience of home hospice physicians and palliative care specialists who care for patients during VSED in Japan, and their opinions on continuous deep sedation (CDS) as a means to relieve patient symptoms during VSED.Methods219 home hospice physicians and 695 palliative care specialists across Japan were surveyed by mail questionnaire in 2016.ResultsA total of 571 (62%) responses were analysed. A total of 185 (32%) had experience of patients who selected VSED. In response to questions about CDS to provide relief to patients during VSED, the number of physicians who replied that CDS was acceptable was 88 (15%).ConclusionsIn Japan, 32% of physicians surveyed replied that they had experience of caring for patients during VSED in a clinical setting and 15% considered CDS acceptable.

Download Full-text

Preferences for place of care and place of death: What, how, when and who to ask?

10.31124/advance.8152538 ◽

2019 ◽

Author(s):

Katrin Gerber ◽

BARBARA HAYES ◽

CHRISTINA BRYANT

Keyword(s):

Palliative Care ◽

End Of Life ◽

Final Stage ◽

Terminally Ill ◽

Healthcare Systems ◽

Place Of Death ◽

Preference Assessments ◽

Terminally Ill Patients ◽

Key Questions

As healthcare systems worldwide are confronted with increasing numbers of ageing and terminally ill patients, the topic of where people want to spend their last days has received considerable attention. However, the strategies that researchers and clinicians use to capture these end-of-life views vary greatly in four key questions. These include: what, how, when and who to ask about location preferences. We will argue that how researchers and clinicians choose to answer these questions directly influences their findings. Based on these considerations, we will highlight ways to improve future palliative care and empirical end-of-life studies by addressing the precision, methods, timing and sources of preference assessments. Only when we are able to accurately identify where people want to spend their last days, can we begin to meet the needs of patients as they approach the final stage of their lives.

Download Full-text

Spiritual dimension in palliative care from the perspective of Thai palliative caregivers

International Journal of Palliative Nursing ◽

10.12968/ijpn.2020.26.2.70 ◽

2020 ◽

Vol 26 (2) ◽

pp. 70-74

Author(s):

Pilaiporn Sukcharoen ◽

Nanchatsan Sakunpong ◽

Kantita Sripa

Keyword(s):

Palliative Care ◽

Health Professionals ◽

Terminally Ill ◽

Self Awareness ◽

Terminally Ill Patients ◽

Care Health ◽

To Receive ◽

Further Development ◽

Depth Interviews

Background: In Thailand, most terminally ill patients die in hospital and are looked after by health professionals. Terminally ill patients tend to receive physical care only, while in the main, spiritual care is neglected. This study aimed to explore spirituality in palliative care health professionals and spiritual leaders in the Thai Buddhist context. Method: In this qualitative case study, seven experienced palliative caregivers took part in in-depth interviews. Thematic analysis and a trustworthiness process were used to analyse the data. Findings: Three themes emerged: (1) the ability for self-awareness and faith; (2) acceptance and compassion for others; and (3) spiritual behaviour while nursing. Conclusion: The results revealed the meaning of spirituality and the necessary characteristics for spirituality in palliative care for the participants, which could serve as a basis for further development.

Download Full-text

Achieving beneficial outcomes for children with life-limiting and life-threatening conditions receiving palliative care and their families: A realist review

Palliative Medicine ◽

10.1177/0269216319870647 ◽

2019 ◽

Vol 34 (3) ◽

pp. 387-402 ◽

Cited By ~ 3

Author(s):

Sarah Mitchell ◽

Karina Bennett ◽

Andrew Morris ◽

Anne-Marie Slowther ◽

Jane Coad ◽

...

Keyword(s):

Palliative Care ◽

Healthcare Professionals ◽

Realist Review ◽

Health Concern ◽

Service Development ◽

Children And Families ◽

Family Outcomes ◽

Number Of Children ◽

Palliative Care Services ◽

Life Threatening

Background: Palliative care for children and young people is a growing global health concern with significant resource implications. Improved understanding of how palliative care provides benefits is necessary as the number of children with life-limiting and life-threatening conditions rises. Aim: The aim is to investigate beneficial outcomes in palliative care from the perspective of children and families and the contexts and hidden mechanisms through which these outcomes can be achieved. Design: This is a systematic realist review following the RAMESES standards. A protocol has been published in PROSPERO (registration no: CRD42018090646). Data sources: An iterative literature search was conducted over 2 years (2015–2017). Empirical research and systematic reviews about the experiences of children and families in relation to palliative care were included. Results: Sixty papers were included. Narrative synthesis and realist analysis led to the proposal of context–mechanism–outcome configurations in four conceptual areas: (1) family adaptation, (2) the child’s situation, (3) relationships with healthcare professionals and (4) access to palliative care services. The presence of two interdependent contexts, the ‘expert’ child and family and established relationships with healthcare professionals, triggers mechanisms, including advocacy and affirmation in decision-making, which lead to important outcomes including an ability to place the emphasis of care on lessening suffering. Important child and family outcomes underpin the delivery of palliative care. Conclusion: Palliative care is a complex, multifactorial intervention. This review provides in-depth understanding into important contexts in which child and family outcomes can be achieved so that they benefit from palliative care and should inform future service development and practice.

Download Full-text

Openness of Health Professionals about Death and Terminal Illness in a Nigerian Teaching Hospital

OMEGA - Journal of Death and Dying ◽

10.2190/5f95-l2f6-elr6-0466 ◽

1997 ◽

Vol 36 (1) ◽

pp. 23-32 ◽

Cited By ~ 4

Author(s):

Kemi Adamolekun

Keyword(s):

Terminal Illness ◽

Terminally Ill ◽

Developed Countries ◽

Terminally Ill Patients ◽

Aids Epidemic ◽

Diagnosis And Prognosis ◽

Threatening Condition ◽

The Face ◽

Life Threatening ◽

Doctors And Nurses

Most physicians in developed countries are reported to have a sense of responsibility to inform a patient about the facts of his or her life-threatening condition. This study reports doctors' and nurses' responsibility to their terminally ill patients in an African environment. Since, by local tradition, doctors are not supposed to convey bad news and the patients do not see themselves as dying of illness, the doctors are not enthusiastic about informing the patients that their disease is terminal. Though doctors and nurses are of the opinion that patients or relatives should be informed of patients' diagnoses, the majority of these professionals do not discuss the prognosis with terminally ill patients. The need to discuss the diagnosis and prognosis according to the desire of each patient was examined. This is more relevant to the practice of medicine in the developing countries with the likelihood that more terminally ill patients would use the hospitals in the face of HIV/AIDS epidemic.

Download Full-text